How we help
Medicare Advantage
One private plan instead of Original Medicare. Lower monthly cost, extras included, a network to stay inside, and a ceiling on what a bad year can cost you.
What it is, exactly
A Medicare Advantage plan, formally Part C, is sold by a private insurance company and approved by Medicare. When you join one, the plan takes over paying your claims instead of the government. It must cover everything Parts A and B cover.
Most plans include Part D drug coverage. Many add dental, vision, hearing, a fitness membership or a quarterly allowance for over-the-counter items. You keep paying your Part B premium of $202.90 a month; many plans charge nothing on top of that.
The four things that decide whether it fits
- Your doctors. Are they in this plan’s network in the coming year, not the year that is ending?
- Your prescriptions. Is each one on the plan’s drug list, and in which tier?
- Your travel. Do you spend months elsewhere, or visit family across the country?
- The worst case. What is the plan’s yearly out-of-pocket maximum, and could you pay it?
What we check that an advert will not tell you
- The network, for next year. Networks are published for the coming plan year. We check each of your doctors by name and, where it is close, we call the office.
- What needs approval in advance. Prior authorization is the single biggest source of frustration we hear about. Some plans require it for scans, rehabilitation and skilled nursing; some require far less. It is in the Evidence of Coverage and we read it.
- The real cost of the extras. A “$3,000 dental benefit” usually means an annual maximum, with coinsurance and waiting periods behind it. We find the number that applies to what you actually need done.
- Star Ratings. Medicare scores every plan from one to five each fall on quality and member experience. It is not everything, but a plan that keeps slipping is telling you something.
- Out-of-network cost. On a PPO this is the number people forget to ask about until they need it.
The one-way door
Leaving Medicare Advantage later is easy in one sense: you can drop back to Original Medicare each fall. But adding a Medigap policy at that point usually means answering health questions, and a company may decline you. Choosing Advantage at 65 is not permanent, but it is not fully reversible either. We would rather you knew that now.
When we think it is the right answer
We recommend Advantage plans often, and not reluctantly. They suit people whose doctors are all local and in-network, who want dental and vision included, who would rather pay when they use care than every month, and who have savings that could absorb the plan’s yearly maximum in a bad year.
They suit people less well if you split the year between two states, if you have a specialist you will not change, or if an unpredictable year would genuinely be a problem.
Switching later
You can change your Advantage plan every fall between October 15 and December 7, and the new plan starts January 1. If you are in an Advantage plan on January 1 you also get one extra change between January 1 and March 31, called the Medicare Advantage Open Enrollment Period.
There are other doors too. If your plan leaves your county, if you move, if you qualify for Extra Help, or if a five-star plan is available where you live, a Special Enrollment Period opens.
See every enrollment window or read about the yearly review.
Send us your doctors and your prescriptions.
We will come back with the plans in your county that cover all of them, priced for a normal year and for a bad one, in writing.